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Just want to be clear that I did not say that "it is not necessary to give cimetidine and gabapentin two hours apart" but rather I said that I did a lot of research, and I can't FIND anything in the literature that indicates that giving the drugs together is a problem. I certainly don't want to be on record here as disagreeing with something that a neurologist tells a client about drug administration.

Since I don't have a dog on SM meds, I've not had a conversation about this with a neurologist. If I were a client and was instructed to not give the drugs together, I'd respectfully ask for the source material/reason for this recommendation. It would be important to me because of my schedule which would make compliance more difficult. Here again is my original quote, and thanks, Nicki, for including my quote!

"From what I've read, I don't see a problem giving gabapentin and cimetidine at the same time and it seems to be an over-generalization to say not to give ANY other drug at the same time. If I had an SM dog on these meds, I'd want to specifically read and understand where the problem is in Plumb's or another drug handbook (added now - or other reference material). Also, I would consider the option of using one of the other H2 receptor antagonists such as omeprazole, ranitidine or famotidine."

Clare tweaks her algorithm from time to time in the light of more experience, but the 2 hour gap for cimetadine is still in place. The only technical information for the compatability of cimetadine with other drugs is for humans, since it is not licensed for use with dogs. So it may be that Clare's experience is that there is some incompatability when it is used with other drugs for dogs - even if this is only true for some, not all, dogs. I'm not sure that you can automatically assume that a drug that works in one way for humans will necessarily work in exactly the same way for dogs, with identical side effects. Don't think it's that easy!

Hi Pat -- I am of the same opinion. I know from direct conversation, that Clare has not been entirely sure of whether there's any actual, significant, interference in the past, but clearly she accepts documentation that there is evidence that cimetidine slows absorption of other drugs and thus includes the recommendation of giving them apart, as evidenced in her algorithm. BUT it is not even clear that this makes much difference in humans, as far as I understand. Let me see if I can find the original citation -- I think Rod has it on Cavalierhealth.org somewhere.

My own experience is that not only has it never made any difference to give them together but I actually think Leo does better when they are given together. He seems a lot more restless when they are given 2 hours apart. It also makes it easy to forget to give the cimetidine. A lot of neurologists do not feel you need to give them apart. Clare is being especially safe on this one, is my sense -- just in case it does make a difference for the given dog.

There is a 'minor' interaction that MAY occur between gabapentin and cimetidine noted there, which is not believed to be clinically significant:

Cimetidine may decrease the clearance of gabapentin by about 14%. The creatinine clearance has also been reported to be decreased by about 10% when cimetidine and gabapentin are coadministered. The mechanism of this interaction is unknown. This interaction is probably not clinically significant.

. The site notes for consumers:

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed

No gabapentin enacarbil dose adjustment is needed with co-administration of naproxen or cimetidine.

The widely used MIMS website -- which provides drug info to medical practitioners -- also clearly states the same info -- the interaction is not considered clinically significant (scroll down near end to interactions):

I will ask Clare again if she feels this is a hard and fast rule but my understanding is that this is really a case of being ultra cautious given the tiny possibility that there might be an affect for some dogs, in the absence of any definitive data.

The only technical information for the compatability of cimetadine with other drugs is for humans, since it is not licensed for use with dogs. So it may be that Clare's experience is that there is some incompatability when it is used with other drugs for dogs - even if this is only true for some, not all, dogs. I'm not sure that you can automatically assume that a drug that works in one way for humans will necessarily work in exactly the same way for dogs, with identical side effects.

Kate, Oliver and Aled

I agree with this - which is why I try not to use sources for humans when seeking information on drugs for veterinary use. But....it's not true that there is no technical information for drugs used in veterinary medicine that are not licensed for use with animals. Plumb's Veterinary Drug Handbook is the US "Bible" for drugs used in veterinary medicine, and it covers ALL drugs used off-label for animals. These drugs are not licensed for use in animals. The dosages, side effects, indications, interactions with food and other drugs, etc. in Plumb's are all for animals, not for humans. It also lists information specifically for dogs, cats, or other animals because the information is not the same for all animals. You can also find information on drugs used off label in the various veterinary textbooks, including indications for use, dosages, side effects, etc. There are many, many drugs used for companion animals that are not licensed for use in animals.

This has evolved into a very useful, informative discussion and I've learned a lot since my initial post.

The more I read, the more this reminds me of warfarin sodium, an anti-coagulant. This drug requires careful monitoring, can interact with other medications and to a lesser degree food. Unfortunately medical personnel lack a basic philosophical knowledge in its use. A patient needs to recognize bad advice and unfortunately the worst, for me, was given in a hospital.

I've been lucky though with a cooperative vet and primary care physician both open to discussion of a different point of view.

The Internet has proven its worth with excellent forums on both subjects and I was lucky to find both of them.

I do not think it is the case that Clare has any indication that there is evidence that dogs have any issues with the two being given together, but I will ask. My understanding from her in the past was that she was simply erring on the side of great caution.

My own experience from giving the two drugs for years now, is that there is no difference -- or a difference to the detriment of NOT giving them together -- perhaps because that means there's no cimetidine in the system for two hours.